Haydarpasa Numune Training and Research Hospital, Department of General Surgery - Istanbul, Turkey.
Rev Assoc Med Bras (1992). 2022 Jan;68(1):77-81. doi: 10.1590/1806-9282.20210787.
The treatment for patients with acute calculous cholecystitis who have high surgical risk with percutaneous cholecystostomy instead of surgery is an appropriate alternative choice. The aim of this study was to examine the promising percutaneous cholecystostomy intervention to share our experiences about the duration of catheter that has yet to be determined.
A total of 163 patients diagnosed with acute calculous cholecystitis and treated with percutaneous cholecystostomy between January 2011 and July 2020 were reviewed retrospectively. The Tokyo Guidelines 2018 were used to diagnose and grade patients with acute cholecystitis.
The mean age was 71.81±12.81 years. According to the Tokyo grading, 143 patients had grade 2 and 20 patients had grade 3 disease. The mean duration of catheter was 39.12±37 (1-270) days. Minimal bile leakage into the peritoneum was noted in 3 (1.8%) patients during the procedure. The rate of complications during follow-up of the patients who underwent percutaneous cholecystostomy was 6.9% (n=11), and the most common complication was catheter dislocation. Cholecystectomy was performed in 33.1% (n=54) of the patients at follow-up. Post-cholecystectomy complication rate was 12.9%. At the follow-up, the rate of recurrent acute cholecystitis episodes was 5.5%, while the mortality rate was 1.8%. The length of follow-up was five years.
The rate of recurrence was significantly higher among the patients with catheter for <21 days. We recommend that the duration of catheter should be minimum 21 days in patients undergoing percutaneous cholecystostomy.
对于经皮胆囊造口术治疗高危手术的急性结石性胆囊炎患者，是一种替代手术的适当选择。本研究旨在探讨经皮胆囊造口术干预的有效性，并分享我们关于尚未确定的导管留置时间的经验。
回顾性分析 2011 年 1 月至 2020 年 7 月期间 163 例经皮胆囊造口术治疗的急性结石性胆囊炎患者。采用 2018 年东京指南诊断和分级急性胆囊炎患者。
患者平均年龄为 71.81±12.81 岁。根据东京分级，143 例患者为 2 级，20 例患者为 3 级。导管留置时间平均为 39.12±37（1-270）天。在手术过程中有 3 例（1.8%）患者出现微量胆汁漏入腹膜。行经皮胆囊造口术患者的随访并发症发生率为 6.9%（n=11），最常见的并发症是导管脱位。在随访中，54 例（33.1%）患者行胆囊切除术。胆囊切除术后并发症发生率为 12.9%。随访时，急性胆囊炎复发率为 5.5%，死亡率为 1.8%。随访时间为 5 年。
导管留置时间<21 天的患者复发率明显较高。我们建议经皮胆囊造口术患者的导管留置时间应至少为 21 天。
